Infertility Treatments – Male Factor
Sperm Extraction and Testicular Biopsy
If there is no sperm in the ejaculate, either PESA, MESA, TESA or TESE will be performed. An Urologist will decide which of these procedures will be the most effective one for the patient. According to this decision, The Urologist and the Embryolog will perform the selected procedure together. Each of these procedures will be performed under local anesthesia.
PESA: Percutaneous testicular aspiration, or non-surgical sperm aspiration, involves entering the testicle with a needle and making multiple passes with a 2-3″ 21 g. needle under high negative pressures. This procedure can be performed in the office using only local anesthesia. Typically, fragments of seminiferous tubules become trapped in the tip of the needle and drawn out to the skin. The sperm are found within the seminiferous tubules. This technique is performed for men with obstructive azoospermia. The advantage of this method is that it is non-surgical and easily repetitive. The disadvantage is that the collected sperm may not be enough.
MESA: Microsurgical Epididymal Sperm Aspiration (MESA) With a MESA procedure, under local anesthesia and general sedation, an incision is made in the scrotum, exposing the epididymus, the tubules immediately adjacent to the testicles that collect the sperm. Using an operating microscope, an incision is made into these tubules and sperm is aspirated. Although millions of motile sperm can often be collected, this sperm has not acquired the ability to penetrate an egg and must be injected into eggs via the IVF-ICSI technique. The advantage of MESA over TESE for men with obstructive azoospermia is that sperm collected in this manner can usually be frozen, and even if his partner has to undergo more than one IVF procedure, the MESA should provide adequate sperm for all subsequent IVF procedures.
TESA: The TESA harvests only a few sperm, not enough to perform simple artificial insemination, but enough to inject the sperm directly into the egg in a process called Intra-Cytoplasmic Sperm Injection or ICSI. In order to acquire the eggs, the female partner of the couple will need to undergo In Vitro Fertilization (IVF); this is done in concert with a female fertility specialist, also known as a Reproductive Endocrinologist. The husband is brought to the operation suite and the area is washed with an antibiotic cleanser. Local anesthesia is administered. A needle, which is attached to a silicone rubber tube, is passed across the scrotum and into the testicle. A vacuum is applied by a syringe and a small amount of fluid is removed. After four passes, the recovered material is evaluated in the adjacent lab. When there is enough sperm the procedure is terminated. The sperm is processed and frozen for future use. Typically, there is enough sperm-obtained for at least two cycles of IVF. Sometimes there is not enough sperm retrieved from the aspiration, and a simple biopsy is required. In that case a small incision is made in the scrotum, then in the testicle, and a small amount of tissue is removed. The scrotum is stitched together with suture that dissolves on its own. Usually, enough sperm are harvested from one side, but on rare occasions the other side is aspirated as well. Whether the sperm is obtained via TESA or biopsy, an ice pack is applied and should stay on for as much of the next 24 hours as possible.
TESE: Testicular sperm extraction : This method is being performed if the sperm production in the testis is minimal. An incision is made under local or general anesthesia, so we can reach the interior of the testis. Then, several layers are taken out from the testis and sperm is being searched under special microscopes in the lab. If there are sperm, we separate them from the layer and use them for the ICSI procedure. Microsurgical TESE is very effective and it increased the chance of finding sperm in azospermic patient.